Face of the future

The medical team for Xu's case has a meeting before Xu's final transplant operation. Lin Dan / for China Daily

"After all, no one in the Fujian hospital or any other hospitals in the province had done it before. It's novel and it's highly risky," Jiang says.

The medical team for Xu's case included six doctors with the orthopedics department, who held several meetings and seminars before they eventually agreed on a three-phrase operation plan.

Phase 1 was to take a piece of blood-vessel fascia (tissue that surrounds vessels and muscles) from Xu's right thigh and implant it in an area between her shoulder and chest. A skin dilator was inserted beneath the part of skin where the blood vessel fascia was planted.

Phase 2 was to let the skin dilator expand the skin and produce enough new tissue for the new face.

Finally, Phase 3: Transplant the new face and mold the shape.

"The skin color of the area between the shoulder and chest is more identical to the face's skin color, compared with other parts of a human body. The area is also close to the face, so it would be convenient when performing the final face transplant," Jiang explains.

The procedure of implanting the fascia, which is known as the flap prefabrication, was the most difficult and crucial part of the whole plan, Jiang says, adding it required connecting blood vessels grafted from the thigh with the ones in the face.

"The diameter of a blood vessel is about a millimeter, so the dovetailing of the blood vessels in the connecting parts required me to do the stitching with a thread thinner than a hair under the microscope," Jiang says.

Although Jiang practiced such stitching many times when he studied the technology in the Shanghai hospital, he admits he felt tremendous pressure.

"The hours of stitching were nerve-wracking. I held my breath to maintain the pace. If the blood vessels failed to properly grow onto one another, the whole plan would fail from the start," Jiang says.

Phase 1 was completed on Nov 26, 2012.